Friday, August 28, 2009

At 12:28 p.m., a Memorial administrator typed “HELP!!!!” and e-mailed colleagues at other Tenet hospitals outside New Orleans, warning that Memorial would have to evacuate more than 180 patients. Around the same time, Deichmann met with many of the roughly two dozen doctors at Memorial and several nurse managers in a stifling nurse-training room on the fourth floor, which became the hospital’s command center. The conversation turned to how the hospital should be emptied. The doctors quickly agreed that babies in the neonatal intensive-care unit, pregnant mothers and critically ill adult I.C.U. patients would be at great risk from the heat and should get first priority. Then Deichmann broached an idea that was nowhere in the hospital’s disaster plans. He suggested that all patients with Do Not Resuscitate orders should go last.

This story from the New York Times Magazine about the breakdown in medical practice in a stranded New Orleans hospital during Katrina will stick with me a long time. Unprepared for the severity or duration of the crisis, believing things in New Orleans to be much worse than in retrospect they were, and apparently significantly undertrained in proper triage procedure or in the deep ethical minefields surrounding end-of-life care (including apparently not understanding what a D.N.R. is), these doctors made some very difficult choices that a layperson like myself cannot possibly judge them for—but what happened at Memorial Medical Center should be standard-issue training in medical, schools, nursing schools, and hospitals so that things never go so badly off the rails again. This was not a zombie attack; it was not the end of the world. Katrina was only a local disaster. To paraphrase the patient quoted in the article: If they have vital signs, Jesus Christ, get ’em out.

Thiele didn’t know Pou by name, but she looked to him like the physician in charge on the second floor. He told me that Pou told him that the Category 3 patients were not going to be moved. He said he thought they appeared close to death and would not have survived an evacuation. He was terrified, he said, of what would happen to them if they were left behind. He expected that the people firing guns into the chaos of New Orleans — “the animals,” he called them — would storm the hospital, looking for drugs after everyone else was gone. “I figured, What would they do, these crazy black people who think they’ve been oppressed for all these years by white people? I mean if they’re capable of shooting at somebody, why are they not capable of raping them or, or, you know, dismembering them? What’s to prevent them from doing things like that?”

The laws of man had broken down, Thiele concluded, and only the laws of God applied.